The great Talking Heads song "No Compassion" begins this way:
In a world
Where people have problems
In this world
Where decisions are a way of life
Other people's problems they overwhelm my mind
They say compassion is a virtue,
But I don't have the time.
There is a surely a tension--in medicine, in psychiatry, in this society--between an insistence on personal responsibility and accountability ("decisions are a way of life") on the one hand and the recognition of suffering and human weakness on the other. Do people truly and fully "decide" to be overweight, to be alcoholics, to smoke, to be depressed, or to "make poor choices" (that wonderful wastebasket phrase for people screwing up their lives for no clear reason we can ascertain), or does some corner of their brain, or even better, some pernicious aspect of their environment, essentially hijack the process and "decide" for them? I don't know the answers, of course, but I have long thought that the central art of medicine is seeking some balance between responsibility and compassion. At the end of a particularly bad day a later lyric might come to mind:
My interest level is dropping, my interest level is dropping
I've heard all I want to, I don't want to hear any more
In contrast somewhat to other specialties, the challenge of psychiatry is probably more emotional than intellectual and technical (we don't have procedures for the most part, and we don't have to worry so much about renal physiology, but compassionate acceptance of those with mental disorders, yes, that is not trivial).